Patient case: Nephrotic Syndrome in Sub-Saharan Africa.
Amina's parents brought her to the local clinic after noticing progressive swelling around her eyes and ankles over the past two weeks. Initially, the swelling was worse in the mornings but later persisted throughout the day. They also reported a significant reduction in her urine output and that her urine appeared "foamy" on several occasions. Amina has been increasingly lethargic and complains of generalized weakness. There is no history of fever, cough, or recent infections, but the family lives in an area with known malaria and schistosomiasis prevalence.
Amina has no significant medical history. Her vaccinations are up to date. The family uses untreated river water for drinking and household purposes.
Vital signs: Normal blood pressure, afebrile
General appearance: Amina appears puffy, especially around her face and ankles. She is malnourished, with visible stunting.
Cardiovascular and respiratory: Normal heart sounds, clear lung fields.
Abdomen: Mild ascites, no tenderness
Extremities: Pitting oedema in both lower limbs
Laboratory Results:
Urinalysis: Heavy proteinuria (+++), no haematuria
Serum albumin: Low (hypalbuminaemia)
Lipid profile: Elevated cholesterol and triglycerides
Renal function tests: Creatinine and urea levels within normal limits.
Based on the clinical presentation, laboratory findings of heavy proteinuria, hypalbuminaemia, and hyperlipidaemias, Amina is diagnosed with nephrotic syndrome, likely secondary to minimal change disease (MCD), a common cause of nephrotic syndrome in children.
Given the rural setting, limited access to tertiary care, and the high prevalence of infections like malaria and schistosomiasis, Amina is started on:
- Prednisolone: To address the underlying glomerular disease.
- Diuretics (Furosemide): For managing edema.
- Nutritional support: To improve her malnourished state.
- Antibiotic prophylaxis: Given the high risk of infections due to her immunocompromised status.
- Health education: Counselling the family on clean water use and the importance of monitoring her urine output and general condition.
Referral to a regional hospital for further evaluation and possible renal biopsy is planned if her condition does not improve with steroid therapy.
a). Acute glomerulonephritis
b). Nephrotic syndrome
c). Urinary tract infection
d). Chronic kidney disease
a). Hypertension
b). Proteinuria
c). Hematuria
d). Hyperkalemia
a). Antibiotics
b). ACE inhibitors
c). Prednisolone
⁸d). Dialysis
a). Hypertension
b). Infections
c). Diabetic nephropathy
d). Renal artery stenosis
Answers
- b) Nephrotic syndrome
- b) Proteinuria
- c) Prednisolone
- b) Infections
